•Arterial tourniquets carry a risk for nerve injury via proposed mechanisms including direct mechanical sheer stress and compression leading to edema and microvascular injury of the nerve.

•We present a case involving the anterior femoral cutaneous nerve (AFCN) and our diagnostic and therapeutic approach.

•A 57-year-old female with a past medical history of polymyalgia rheumatic and chronic lower back pain underwent a right knee arthroscopic meniscectomy in September of 2019.

•Immediately following procedure, she developed ecchymosis and swelling of the anterior distal thigh thought to be secondary to tourniquet use.

•One year post-operatively, she continued to have intermittent weakness and paresthesia of the medial distal thigh.

•She underwent epidural steroid injections at an outside hospital to treat presumed radiculopathy from neuroforaminal stenosis in 2020 and 2021.

•In November of 2022, she underwent anterior femoral cutaneous nerve diagnostic block with four hours of complete resolution of symptoms leading to cryoablation – and ultimately, resection of the AFCN in 2023.

•Diagnosis of an injury to a peripheral sensory nerve such as the AFCN poses as a diagnostic challenge.

•Our diagnostic approach includes a block proximal to the suspected region of nerve injury prior to neurolysis or  neurectomy.

•In patients who benefit from cryoablation of peripheral sensory nerves, definitive resection may yield long-lasting analgesia.